Loading...
HomeMy WebLinkAbout5220 Boardwalk Dr - Applications/Reroof - 04/02/2012 (18)04/02/2012 10:29 9705930124 1 GOLD ROOFING INC PAGE 17/24 (�Wd'b � +} f'`� Plannirrg, Den►Ealopmeatt & Trartsp0ltation F®! ` CVLlins FortNCO GoWns, p80524 .O. Box 580 Phone 970-416-2740 Fax 224-6134 OVER-THE-COUNTER PERMITS ONLY This application is to be used to apply for the following permits only (check all that apply). O Air Conditioning " ❑ Demoffion (interior not -structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas log ❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement KRoofing ❑ Sewer.Line ❑ Photo -voltaic 0 ventilation ❑ Water Heater 17 Water Line 13 Wood/Pefiet Stove (must be EP'A certified, provide make, model and manufacturer). Complete all applicable iwornwMon on the application. Incomplete applicatiions will not be accepted.1 90 Application # ?� -Date2 I . For ofnx-Lac wrq .. Job Site Address (1154Mrodl Value a cor atrucum (labor, materials, profit) Po szS 1 $ fig. b S ri ?roperty Owner Name 60JOACq•-) Address City/State Zip Phone Pr /55A), Celli Ste � do 9052q Apmi nt Name Address City/State Zip Phone S Corib-actor U Lic # Address Cftylymw bold &6,fWA �vefa Zip 7 67,5)Phone 5-93 Sao Contractor City of Ft CtAins Sales Tax # Are you paying taxes he re or by report? Are you paying with youirtrust account? d(.Here 0 Report AeYes ❑ No Saks tar nunbwIF fawAmdbyal/cardraC=- 3z5 Is this a residential or commercial project? ❑ Residential commercial If residential, is it ❑ Smgle Family DeMdted 13 Condo/owhome (single FamlN atbuted) ❑ M plea Gt Multifamily (apartment) ❑ Garage If commerdal, is rc CI Bank 0 Bar D yturch © Hotel/ Medical office Office❑ Rail O Restawant obd Other (explain) 2/00-14 Is this budding so years of age or more? ❑ Yes )T610 oyes, you may Imwto wntaa Arnw& Pneswvatron If this is fir a demolition permit, what year was the buikiing osnstnictled? Ifprior io -t94 you wNneed an asbestos assess7nerit to submit w/di h*axyk3wJ7 ra.« 611• • *If lawn sprmlW/baddiow preverdw, must fist licensed pimiber. if W-time A/C, mast filet ftertsed etetUidan. Subcontractors:ustMecompany name or[31yofRCol6ns 0 5earUUn p Roofier ►� •J Other I hereby advwraledW that I have read this apptxaljim and state that ttte above Iriftr boi n is complete and comecL I agree b0 comply wnh all requirements cort�med herein and aty ordinances and state hms reguldin g building . I know that a permit is not valid until it has been paW and ism!& Appllmnt Printer ��rnQ`Ir Sknaha+e - Date G 7 f� �i